Individual
NICHOLAS PORTELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2121 ZUMBEHL RD, SAINT CHARLES, MO 63303-2724
(636) 949-2906
(636) 949-2914
Mailing address
PO BOX 207158, DALLAS, TX 75320-7158
(636) 200-4393
(636) 527-0766
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2020015799
MO
Other
Enumeration date
06/12/2020
Last updated
04/26/2021
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